Assessment of Impact of Long-Cassette Standing X-Rays on Surgical Planning for Cervical Pathology: An International Survey of Spine Surgeons

作者：Ramchandran Subaraman; Smith Justin S; Ailon Tamir; Klineberg Eric; Shaffrey Christopher; Lafage Virginie; Schwab Frank; Bess Shay; Daniels Alan; Scheer Justin K; Protopsaltis Themi S; Arnold Paul; Haid Regis W Jr; Chapman Jens; Fehlings Michael G; Ames Christopher P

来源：Neurosurgery, 2016, 78(5): 717-724.

DOI：10.1227/NEU.0000000000001128

• Cervical deformity
• Spinal alignment
• Standing radiographs
• Surgery

BACKGROUND:Understanding the role of regional segments of the spine in maintaining global balance has garnered significant attention recently. Long-cassette radiographs (LCR) are necessary to evaluate global spinopelvic alignment. However, it is unclear how LCRs impact operative decision-making for cervical spine pathology.OBJECTIVE:To evaluate whether the addition of LCRs results in changes to respondents' operative plans compared to standard imaging of the involved cervical spine in an international survey of spine surgeons.METHODS:Fifteen cases (5 control cases with normal and 10 test cases with abnormal global alignment) of cervical pathology were presented online with a vignette and cervical imaging. Surgeons were asked to select a surgical plan from 6 options, ranging from the least (1 point) to most (6 points) extensive. Cases were then reordered and presented again with LCRs and the same surgical plan question.RESULTS:One hundred fifty-seven surgeons completed the survey, of which 79% were spine fellowship trained. The mean response scores for surgical plan increased from 3.28 to 4.0 (P = .003) for test cases with the addition of LCRs. However, no significant changes (P = .10) were identified for the control cases. In 4 of the test cases with significant mid thoracic kyphosis, 29% of participants opted for the more extensive surgical options of extension to the mid and lower thoracic spine when they were provided with cervical imaging only, which significantly increased to 58.3% upon addition of LCRs.CONCLUSION:In planning for cervical spine surgery, surgeons should maintain a low threshold for obtaining LCRs to assess global spinopelvic alignment.ABBREVIATIONS:HRQOL, health-related quality of lifeLCR, long-cassette radiographsSVA, sagittal vertical axis

• 出版日期2016-5
• 单位西北大学